Subclinical and Asymptomatic Atrial Fibrillation: Current Evidence and Unsolved Questions in Clinical Practice

Abstract

Atrial Fibrillation (AF) may be diagnosed due to symptoms, or it may be found as an incidental electrocardiogram (ECG) finding, or by implanted devices recordings in asymptomatic patients. While anticoagulation, according to individual risk profile, has proven definitely beneficial in terms of prognosis, rhythm control strategies only demonstrated consistent benefits in terms of quality of life. In fact, evidence collected by observational data showed significant benefits in terms of mortality, stroke incidence, and prevention of cognitive impairment for patients referred to AF catheter ablation compared to those medically treated, however randomized trials failed to confirm such results. The aims of this review are to summarize current evidence regarding the treatment specifically of subclinical and asymptomatic AF, to discuss potential benefits of rhythm control therapy, and to highlight unclear areas.

Atrial fibrillation and coronary artery disease: a review on the optimal use of oral anticoagulants

“…Atrial fibrillation (AF) is the most prevalent arrhythmia in adult patients worldwide and its prevalence is expected to rise due to increased longevity of the general population [1][2][3][4][5]. The incidence of AF in patients experiencing an acute coronary syndrome (ACS) stands at 2-23% and AF itself may be associated with a higher risk of myocardial infarction (MI) [6,7].…”

Application of Dense Neural Networks for Detection of Atrial Fibrillation and Ranking of Augmented ECG Feature Set

“…Confirmation of AF requires rhythm documentation with an electrocardiogram (ECG), showing heart rhythm with no discernible P-waves and irregular RR intervals [ 1 , 5 ]. However, in the real clinical practice, many patients with recurrent episodes of paroxysmal AF are often in normal sinus rhythm at the time of clinical visits [ 1 , 6 ]. On the other hand, short and asymptomatic AF episodes possess similar stoke potential as the longer ones, and it is not uncommon AF patients to present first with an ischemic stroke [ 1 , 2 , 3 ].…”

“…On the other hand, short and asymptomatic AF episodes possess similar stoke potential as the longer ones, and it is not uncommon AF patients to present first with an ischemic stroke [ 1 , 2 , 3 ]. Since standard 12-lead ECG strips during clinical visits are unreliable to confirm or reject recurrent episodes of AF, clinicians count a lot on ECG monitoring techniques like 24–72 h Holter-ECG monitors and loop recorders, tracing patient’s rhythm for days to several weeks [ 1 , 6 , 7 ]. Today, these methods have become routine to detect paroxysmal, self-limited rhythm and conductance disorders often not detected by short-term ECG strips [ 1 , 5 , 7 ].…”

“…Today, these methods have become routine to detect paroxysmal, self-limited rhythm and conductance disorders often not detected by short-term ECG strips [ 1 , 5 , 7 ]. However, they turn out to not be the perfect solution for arrhythmia diagnosis for many patients [ 5 , 6 , 7 ]. Most of the ECG monitoring devices are single- to three-lead and may not reliably depict important components for the correct diagnosis of the record, particularly the low-amplitude ‘P’-waves of normal atrial depolarisation in sinus rhythm from the ‘saw-like’ waves of atrial excitation in atrial flutter or the fine deviations of the isoelectric line (’f’-waves) in AF [ 5 , 6 , 7 , 8 ].…”

“…However, they turn out to not be the perfect solution for arrhythmia diagnosis for many patients [ 5 , 6 , 7 ]. Most of the ECG monitoring devices are single- to three-lead and may not reliably depict important components for the correct diagnosis of the record, particularly the low-amplitude ‘P’-waves of normal atrial depolarisation in sinus rhythm from the ‘saw-like’ waves of atrial excitation in atrial flutter or the fine deviations of the isoelectric line (’f’-waves) in AF [ 5 , 6 , 7 , 8 ]. Differentiation between atrial fibrillation and flutter may become even more difficult if the unidentifiable waves of atrial excitation are combined with alternating atrio–ventricular conductance.…”